Anal fissure for a long time, can heal itself?

Those who have experienced anal fissure should have experienced the pain of anal fissure: when the opening is big, the anus is torn and bleeding. Usually, the anus is painful and itchy, which makes it difficult to sit upright. Eat plain porridge everyday to recover anal fissure, but not long, the anal fissure will come again, so that people fall into the vicious circle of "anal fissure pain ¡ª relief ¡ª the recurrence of anal fissure ¨C relief ". So, can anal fissure heal itself? To answer this question, we must start with the pathogenesis of anal fissure.

The position of the anal fissure

It is called anal fissure because the anal canal is cracked and the cleft has a fixed position. That is, it is always located on the posterior median line of the anal canal (the incidence is about 75%), only 15% in the anterior median, and 10% in the anteroposterior position. At present, the latest concept holds that the essence of anal fissure is ischemic ulcer, which is different from that after hemorrhoid surgery. After hemorrhoid surgery, there was no wound ischemia, so it could be healed (except for anal stenosis after hemorrhoids operation).

Pathogenesis of anal fissure

First, lack of blood vessels in the posterior and middle of the anus is the basis of anal fissure pathogenesis. It was confirmed that after anal fissure, the supply of blood vessels in the median is obviously lower than that on the two sides of the anal canal. Therefore, there is a relatively lack of blood transport in the posterior median, and once the anus is damaged, the natural healing is slow.

Third, an angle of about ninety degrees appears at the end of the anal and rectum due to the traction of the sphincter. This angle makes the fecal decline in the rear of the anus significantly higher than that in front of the anus, so the opportunity for the rear anus to be impacted to the crack is much higher than that in other places.

Fourth, mental factors. A medical scientist has confirmed that the mental excessively tension or anxiety can stimulate the chemoreceptor in the internal sphincter through the sympathetic nerve and increase the sensitivity of the muscle fibers; constipation, diarrhea, spicy stimulation and other factors are easy to make sphincter spasm.

Fifth, internal sphincter spasm is the root cause of anal fissure not healing. If occasional constipation damages the anal skin, after timely medication, such as wash with Chinese and western medicine, apply ointment, oral cathartic drugs, etc., the wound will generally heal. But if there is no medication for a period of time, it is easy to develop chronic anal fissure. Clinically, almost all chronic anal fissure has different degrees of internal sphincter high tension and high anal pressure, which is the result of spasm of internal sphincter. The direct cause of spasm is the stimulation of chronic inflammation of anal fissure.

In addition, the internal sphincter is characterized difficulty in fatigue. Even under anaesthesia, although the pain in the anus is gone, the spasm still exists.

Sixth, chronic anal fissure, fissure basilar fibrosis, cicatricial scar is obvious; around the crack, because of the inflammatory irritation and hyperplasia, causing the skin on both sides of the cleft to protruding out of the anus, forming an increasing puffiness
called the sentinel hemorrhoids. Because of the appearance of sentinel hemorrhoids, the original drainage is not smooth enough to make the wound more difficult to heal.

Seventh, the long untreated anal fissure, due to the recurrent stimulation of the pain, the long spasm of the internal sphincter, tends to form fibrosis in the surface of the sphincter, and the anus is narrow and difficult to defecate. The more painful the cramp, the more obvious the spasm will be. A vicious cycle is formed. With the stimulation of each bowel movement, a vicious cycle occurs repeatedly, which makes the anal fissure can not heal itself.